Las Vegas Conference 2017

Hospital Procedure Consultants
More Articles – Events, Gastrointestinal diseases, Hospital Procedures, Medical General, Travel
More Tags – Bellagio, conference, hospitalist, HPC, Las Vegas, Miracle Mile Shops, Planet Hollywood, travel blog
Landed in Las Vegas for Our Conference at the Amazing Planet Hollywood Resort and Hotel. It was great to see all the familiar faces and many new ones from across the country. Enjoyed walking along the trendy shops and playing the…
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Anticoagulation is Likely Beneficial for Portal Vein Thrombosis in Cirrhosis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Hematology, Medical General, medical procedures, Thoracentesis
More Tags – anticoagulation, cirrhosis, HPC updates, portal vein thrombosis
The optimal treatment of portal vein thrombosis in patients with cirrhosis has been a topic of debate for quite some time.  To this date there have been no large prospective, randomized controlled trials to help guide management in these patients. …
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Higher Baseline Serum Creatinine Increases Mortality for Hospitalized Patients with Cirrhosis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, medical procedures, Nephrology, Paracentesis
More Tags – acute kidney injury, cirrhosis, HPC updates
The International Ascites Club (IAC) recently defined Stage 1 acute kidney injury (AKI) for cirrhosis as an acute increase in serum creatinine (SCr) by ≥0.3 mg/dl or by more than 50% in <48 h from a stable value within 3 months. North…
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Misdiagnosed Cellulitis Increases Unnecessary Hospital Admissions and Antibiotic Use

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Dermatology, Emergency Procedures, Gastrointestinal diseases, Hematology, Infections, medical procedures
More Tags – cellulitis, contact dermatitis, gout or pseudogout, HPC updates, skin infection, venous stasis dermatitis, venous thrombosis
There are multiple noninfectious medical disorders that mimic cellulits.  In this retrospective study, researchers focused on misdiagnosis of cellulitis in 259 patients hospitalized with presumed diagnoses of lower extremity cellulitis at a Boston teaching hospital. Patients with complicating factors (e.g.,…
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To Intubate or Not Intubate During In-Hospital Codes?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Gastrointestinal diseases, Medical General, medical procedures, Respiratory diseases
More Tags – advanced airway, asystole, cardiac arrest, CPR, HPC updates, intubation, PEA, pulseless electrical activity, ROSC, ventricular fibrillation, ventricular tachycardia
The 2015 American Heart Association Advanced Cardiovascular Life Support guidelines deemphasizes advanced airway placement during the initial resuscitation. Out-of-hospital–arrest data suggest lower survival among patients who are intubated in the field.  Therefore, it is important to determine the importance of…
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Predictors of Difficult Intubation with Hypercurved Glidescope or C-MAC devices

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Gastrointestinal diseases, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – C-MAC D-blade, Difficult Intubation, GlideScope, HPC updates, intubation, Videolaryngoscopy
Investigators have conducted a secondary analysis in order to identify predictors of difficult or prolonged intubation with hypercurved videolaryngoscopes. The analysis was of a randomized control trial of 1100 elective surgery patients. After anesthesia and neuromuscular blockade, these patients were…
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Las Vegas in the Summer

Hospital Procedure Consultants
More Articles – Gastrointestinal diseases, Hospital Procedures, Medical General, Travel
More Tags – Conservatory at Bellagio, Las Vegas, M&M's World, Travel, travel blog
Las Vegas in the Summer Our second trip to Vegas this year was great. Our conference was held at Planet Hollywood Resort, July 23rd and 24th.  The summertime crowds had the casino buzzing and Britney was playing in every elevator. It was electric!…
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Why are Patients with Cirrhosis Readmitted to the Hospital?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Hospital Procedures, Medical General, medical procedures
More Tags – Alcoholic liver disease, cirrhosis, HPC updates, Nonalcoholic liver disease, readmission
Patients diagnosed with cirrhosis are regularly admitted and readmitted to the hospital. Statistics show that the 90-day readmission rate is approximately 50%. A recent study analyzed the rate of readmission at 30-days and 90-days and the relevant causes among patients…
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Predictors of failed intubations using video laryngoscopy such as failed Glidescope intubations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – airway management, direct laryngoscopy, endotracheal intubation, Glidescope intubation, HPC updates, intubation, video laryngoscopy
In a study conducted at two academic medical centers, records showed that of 71,570 intubations 2,004 used Glidescope for airway management. Success rates and complications were documented in these Glidescope intubations. The overall success rate for Glidescope intubations was 97%.…
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GlideScope VL Improves Success of Urgent Intubation by ICU Physicians

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endotracheal Intubation, Gastrointestinal diseases, Glidescope Intubation, King Tube, medical procedures, Respiratory diseases
More Tags – direct laryngoscopy, endotracheal intubation, Glidescope intubation, HPC updates, rapid sequence intubation
Use of video laryngoscopy (VL) results in improved glottic views, fewer intubation attempts, and higher intubation success in both operating room and emergency department (ED) patients. Less is known about performance characteristics of VL during urgent inpatient intubations performed in…
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Hepatic Encephalopathy with Acute Decompensated Cirrhosis and Acute-on- Chronic Liver Failure

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Hematology, Hospital Procedures, medical procedures
More Tags – cirrhosis, GI bleeding, hepatic encephalopathy, HPC updates
Hepatic encephalopathy (HE) is one of the major complications of cirrhosis, and recent evidence suggests that hospitalized cirrhotic HE patients with acute decompensation and, especially, acute-on-chronic liver failure (ACLF) have extremely poor outcomes. The current review article discusses the pathophysiology…
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Choosing Wisely Recommendations by the CCSC

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – choosing wisely, HPC updates, mechanical ventilation, parenteral nutrition, transfusions
CHOOSING WISELY RECOMMENDATIONS FROM THE CRITICAL CARE SOCIETIES COLLABORATIVE 1. Don’t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions. Many diagnostic studies (including chest radiographs, arterial blood gases, blood chemistries…
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Nutrition in Acute Pancreatitis: Have We Come Full Circle?

Hospital Procedure Consultants
More Articles – Gastrointestinal diseases, Mechanical Ventilation, medical procedures
More Tags – HPC updates, Pancreatitis
Nutrition in Acute Pancreatitis: Have We Come Full Circle? Preface:  This randomized controlled trial demonstrated that early tube feeding is not superior to delayed initiation of oral feeds in patients with severe acute pancreatitis. Study: Current guidelines recommend early use…
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Clinical Course after Episodes of Diverticulitis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Gastrointestinal diseases, medical procedures
More Tags – diverticulitis, HPC updates
In nonoperatively managed patients, ≈7% of patients had recurrent episodes, and 2% required emergency surgery during 4 years of follow-up. Some surgeons promote elective surgery after one or two episodes of uncomplicated diverticulitis to prevent recurrences that might require urgent…
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Is oral contrast added to IV contrast necessary for the detection of acute appendicitis?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Gastrointestinal diseases, Medical General, medical procedures
More Tags – acute appendicitis, appendicitis, HPC updates, oral contrast, quality care, randomized trial
In three single-center, randomized trials, oral contrast — given in addition to intravenous (IV) contrast — did not improve the diagnostic accuracy of computed tomographic (CT) scanning for suspected appendicitis. To determine whether this conclusion is generally valid, researchers analyzed…
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